cardio page 276 - 280 Flashcards
what the 2 cases that S3 is normal?
- in children
2. pregnant women
what wave is due to RV contraction (closed tricuspid valve bulging into atrium)?
c wave
when is S4 best heard?
at apex with pt in Lt. lateral decubitus position
what 2 paths are associated with S4?
- ventricular hypertrophy
2. hypertrophic cardiomyopathy
what is the mech of S4 heart sound?
Lt. atrium pushing against still LV wall also known as atrial kick (takes place in late diastole)
what heart murmur is associated with syncope, angina, dyspnea on exertion?
aortic stenosis
name all the holosystolic murmur
mitral/tricuspid regurge, VSD
which murmurs are loudest at tricuspid area?
VSD, tricuspid regurge
where is the tricuspid area?
5th intercostal and Lt. lower sternal border
what is pulsus parvus et tardus? what path is associated with it?
pulses are weak with a delayed peak, aortic stenosis
name 2 paths associated with aortic stenosis?
- age related calcification
2. early onset calcification of bicuspid aortic valve
what murmur is described as “high pitched blowing early diastolic decrescendo murmur?”
aortic regurgitation
name 5 paths associated with aortic regurgitation
- aortic root dilation
- bicuspid aortic valve
- endocarditis
- rheumatic fever
- Lt. HF
PDA is a continuous machine like murmur loudest at
S2
where is PDA murmur best heard?
Lt. infraclavicular area
describe murmur sound for mitral valve prolapse
late systolic crescendo murmur with midsystolic click
why do you get mid systolic click in MVP?
due to sudden tensing of chordae tendineae
what is the most frequent valvular lesion?
MVP
will dec preload lead to dec or inc MVP murmur?
inc, early onset of click/murmur
which 2 beside maneuvers will dec preload?
- valsalva (phase 2)
2. standing up
what are the 2 murmurs that become louder with dec preload?
- MVP
2. hypertrophic cardiomyopathy murmur
what bedside maneuver inc afterload?
hand grip
what bedside maneuver inc preload?
rapid squatting and leg raising
during inspiration, describe the preload (venous return) change in Rt. and Lt. side of heart
- inc preload in Rt. side
2. dec preload in Lt. side
name all the systolic heart murmur? (6 of them)
- aortic/pulmonic stenosis
- mitral/tricuspid regurge
- VSD
- MVP
name all the diastolic heart murmur (4 of them)
- aortic/pulmonic regurge
2. mitral/tricuspid stenosis
what are the 3 bedside maneuvers that increases venous return (preload)?
- inspiration
- rapid squatting
- leg raising
name 2 paths associated with paradoxical splitting
- aortic stenosis
2. Lt. bundle branch block
describe normal spltting
it’s a splitting of S2. since the pressure is less in the lung than in the system, aortic valve is closed faster than the pulmonic valve
is the splitting btw A2 and P2 wider or narrower in expiration?
narrower
what 2 paths are associated with wide splitting of S2?
- pulmonic stenosis
2. Rt. bundle branch block
name 2 paths associated with S4 heart sound?
- ventricular hypertrophy
2. hypertrophic cardiomyopathy
cardiac myocytes are electrically coupled to each other by
gap junction
the plateau of the cardiac muscle action potential is maintained by what 2 currents?
- Ca2+ influx
2. K+ efflux
myocardial action potential is made of how many phases?
phase 0 - 4
explain briefly what takes place during each phase of the myocardial action potential (from phase 0 to 4)
- phase 0: opening of the voltage gated Na+ channel
- phase 1: inactivation of voltage gated Na+ channel, voltage gated K+ channels begin to open
- phase 2: plateau (Ca2+ influx, K+ efflux)
- phase 3: repolarization by K+ efflux
- phase 4: resting potential by high K+ permeability
during the plateau of phase 2, Ca2+ influx triggers what?
Ca2+ release from sarcoplasmic reticulum and myocyte contraction
during inspiration, explain the changes of preload of Lt and Rt side of the heart and changes of the effect on mitral/tricuspid murmur
during inspiration
- dec preload on Lt. side –> dec mitral murmur
- inc preload on Rt. side –> inc tricuspid murmur
name 3 bedside maneuvers that inc preload/venous return to the Rt. atrium
- inspiration
- rapid squatting
- leg raising
how does squatting affect the TPR (total peripheral resistance)?
inc TPR
how does the intensity of AS murmur change with squatting?
inc (b/c TPR inc)
in what path does squatting improve cyanosis by dec Rt. to Lt. shunt?
tetrology of fallot
valsalva phase 2 and standing up dec preload thus dec most heart murmur except for 2 murmurs. what are they?
- hypertrophic cardiomyopathy murmur
2. MVP (leads to earlier onset of click/murmur)
name all the jugular venous pulse
a, c, v waves
x, y descents
